I have 29876 for the synovectomy
29881 for menisectomy
29879?
G0289?
Could please use some input/thoughts I am still fairly new to Ortho.
TIA
Melissa Bedford,CCS,CPC
PREOPERATIVE DIAGNOSIS:
Left knee synovitis, possible meniscal tear and arthritis.
POSTOPERATIVE DIAGNOSES:
Left knee pain, synovitis with inflamed plica, medial femoral
condyle articular cartilage injury, mild arthritis, posterior
horn tear of the medial meniscus, multiple cartilaginous loose
bodies greater than 10.
PROCEDURE:
Arthroscopic examination with synovectomy in all compartments,
removal of multiple loose bodies, abrasion arthroplasty with
microfracture of medial femoral condyle, and partial medial
meniscectomy.
SURGEON:
ANESTHESIA:
General LMA.
ESTIMATED BLOOD LOSS:
Minimal.
COMPLICATIONS:
None.
TOURNIQUET TIME:
About 29 minutes.
PROCEDURE:
After taking informed consent, the patient was brought to the
operating room, placed on operating room table in supine
position. After administration of general LMA anesthesia,
time-out was performed. The patient was identified,
appropriate biopsy site was marked and he received appropriate
antibiotics. Next, a tourniquet was placed on the proximal
thigh and the skin was prepped and 0.5% lidocaine with
epinephrine was placed in the knee joint. Next, the left leg
was sterilely prepped and draped in a routine manner. An
anterolateral arthroscopy portal was then made and
arthroscopic examination of the joint was performed.
Examination of the suprapatellar area showed inflammation of
the synovium. The patellofemoral joint was normal in
appearance. The medial gutter showed a thickened inflamed
medial plica and some cartilaginous loose bodies. The medial
joint was examined. It was on a very thickened, inflamed
synovium which made visualization of the medial joint
difficult and spinal needle was used to help make an
anteromedial portal and inflamed synovium was debrided to help
with visualization of the medial joint. There was some
bleeding noted and the tourniquet was inflated. Next, he was
noted to have about 1 cm area of exposed subchondral bone and
fibrillated articular cartilage. There were some loose bodies
noted here also. There was a tear at the insight edge of the
posterior horn of the medial meniscus. The notch area was
examined and the ACL and PCL were intact as was the ligament
of mucosum. Next, with the aid of a punch and shaver, partial
medial meniscectomy was performed. Next, the shaver was used
to debride the end of the medial femoral condyle down to
stable cartilage and bone and microfracture was done on the
area of articular cartilage injury. Good microfracture was
noted. Next, the lateral side was addressed. The meniscus
was probed and noted to be stable. There were a few small
loose bodies noted here and lateral gutters were examined.
There was a large collection of loose bodies noted there also.
Next, with aid of the shaver, the inflamed plica was noted,
inflamed synovium was debrided in all compartments and the
loose bodies were also removed in both the gutters and joint
in the suprapatellar area, third debridement of loose bodies
were noted. No further loose bodies were noted. The back of
the knee was palpated to help loosen any of the loose bodies
that might be posteriorly. Third debridement was performed.
Next, the arthroscope was removed from the knee joint.
Steri-Strips used to approximate the skin edges and the
portals and joint were infiltrated with 1% lidocaine. A
sterile dressing was applied and the patient was transferred
to recovery in stable condition.
29881 for menisectomy
29879?
G0289?
Could please use some input/thoughts I am still fairly new to Ortho.
TIA
Melissa Bedford,CCS,CPC
PREOPERATIVE DIAGNOSIS:
Left knee synovitis, possible meniscal tear and arthritis.
POSTOPERATIVE DIAGNOSES:
Left knee pain, synovitis with inflamed plica, medial femoral
condyle articular cartilage injury, mild arthritis, posterior
horn tear of the medial meniscus, multiple cartilaginous loose
bodies greater than 10.
PROCEDURE:
Arthroscopic examination with synovectomy in all compartments,
removal of multiple loose bodies, abrasion arthroplasty with
microfracture of medial femoral condyle, and partial medial
meniscectomy.
SURGEON:
ANESTHESIA:
General LMA.
ESTIMATED BLOOD LOSS:
Minimal.
COMPLICATIONS:
None.
TOURNIQUET TIME:
About 29 minutes.
PROCEDURE:
After taking informed consent, the patient was brought to the
operating room, placed on operating room table in supine
position. After administration of general LMA anesthesia,
time-out was performed. The patient was identified,
appropriate biopsy site was marked and he received appropriate
antibiotics. Next, a tourniquet was placed on the proximal
thigh and the skin was prepped and 0.5% lidocaine with
epinephrine was placed in the knee joint. Next, the left leg
was sterilely prepped and draped in a routine manner. An
anterolateral arthroscopy portal was then made and
arthroscopic examination of the joint was performed.
Examination of the suprapatellar area showed inflammation of
the synovium. The patellofemoral joint was normal in
appearance. The medial gutter showed a thickened inflamed
medial plica and some cartilaginous loose bodies. The medial
joint was examined. It was on a very thickened, inflamed
synovium which made visualization of the medial joint
difficult and spinal needle was used to help make an
anteromedial portal and inflamed synovium was debrided to help
with visualization of the medial joint. There was some
bleeding noted and the tourniquet was inflated. Next, he was
noted to have about 1 cm area of exposed subchondral bone and
fibrillated articular cartilage. There were some loose bodies
noted here also. There was a tear at the insight edge of the
posterior horn of the medial meniscus. The notch area was
examined and the ACL and PCL were intact as was the ligament
of mucosum. Next, with the aid of a punch and shaver, partial
medial meniscectomy was performed. Next, the shaver was used
to debride the end of the medial femoral condyle down to
stable cartilage and bone and microfracture was done on the
area of articular cartilage injury. Good microfracture was
noted. Next, the lateral side was addressed. The meniscus
was probed and noted to be stable. There were a few small
loose bodies noted here and lateral gutters were examined.
There was a large collection of loose bodies noted there also.
Next, with aid of the shaver, the inflamed plica was noted,
inflamed synovium was debrided in all compartments and the
loose bodies were also removed in both the gutters and joint
in the suprapatellar area, third debridement of loose bodies
were noted. No further loose bodies were noted. The back of
the knee was palpated to help loosen any of the loose bodies
that might be posteriorly. Third debridement was performed.
Next, the arthroscope was removed from the knee joint.
Steri-Strips used to approximate the skin edges and the
portals and joint were infiltrated with 1% lidocaine. A
sterile dressing was applied and the patient was transferred
to recovery in stable condition.
